Regional obesity and risk of cardiovascular disease; the Framingham study

doi:10.1016/0895-4356(91)90265-B

Journal of Clinical Epidemiology

Volume 44, Issue 2, 1991, Pages 183-190

https://doi.org/10.1016/0895-4356(91)90265-B Get rights and content

Abstract

Risk of cardiovascular events was determined over 24 years of surveillance in relation to general adiposity reflected by relative weight and by regional obesity estimated by skinfolds and waist girth per inch of height. Upper quintile values of relative weight, subscapular skinfolds and waist girth were each associated with increased risks of cardiovascular disease in both sexes. Risk of total cardiovascular events increased with the degree of regional, central or abdominal obesity. Mortality from cardiovascular disease was also increased. Increased relative weight and central obesity were both associated with increased risk factors including cholesterol, blood pressure, glucose and uric acid. Changes in weight were mirrored by changes in risk factors with linear trends over a 15 lb range of weight fluctuations. Subscapular skinfold and the ratio of subscapular-to-triceps skinfold, measures of central obesity, were in either sex also associated with an increased probability of coronary attacks in particular. The subscapular skinfold contributed to CHD risk independent of body mass index (BMI). Multivariate analyses taking all the risk factors into account indicate an independent effect of abdominal obesity on stroke, cardiac failure and cardiovascular and all-cause mortality in men. In women, only the subscapular-to-triceps skinfold ratio independently contributes to CHD, cardiovascular and all cause mortality. Regional obesity appears to be an independent contributor to cardiovascular disease at a given level of general adiposity, its effect only partially mediated through promotion of other known risk factors. These data suggest that cardiovascular disease is as closely linked to abdominal as to general adiposity.

References (30)

A.J. Hartz et al.
Relation of obesity to diabetes: influence of obesity level and body fat distribution
Prov Med
(1983)
A.M. Fournier et al.
Blood pressure, insulin and glycemia in non-diabetic subjects
Am J Med
(1986)
R.F. Gillum
The association of the ratio of waist to hip girth with blood pressure, serum cholesterol and serum uric acid in children and youths aged 6–17 years
J Chron Dis
(1987)
R.F. Gillum
The association of body fat distribution with hypertension, hypertensive heart disease, coronary heart disease, diabetes and cardiovascular risk factors in men and women aged 18–79 years
J Chron Dis
(1987)
R.P. Donahue et al.
Central obesity and coronary heart disease in men
Lancet
(1987)
Report of the Royal Society of Physicians. Obesity
J R Coll Phys London
(1983)
A.P. Simopoulos et al.
Body weight health and longevity
Ann Intern Med
(1984)
W.B. Kannel
M. Higgins et al.
Hazards of obesity, The Framingham Experinence
Acta Med Scand
(1988)
Health Implications of Obesity: National Institute of Health Consensus Development Statement
Ann Intern Med
(1985)

E. Barrett-Connor

Obesity, atherosclerosis and coronary artery disease

Ann Intern Med

(1985)

R.J. Jarrett

Is there an ideal body weight?

Br Med J

(1986)

A. Damon et al.

Predicting somatotype from body measurements

Am J Phys Anthropol

(1962)

H.T.E. Hertzberg et al.

Anthropometry of flying personnel—1950

A.R. Behnke

The estimation of lean body weight from “skeletal” measurements

Hum Biol

(1959)

Cited by (443)

Growth and adiposity in newborns study (GAINS): The influence of prenatal DHA supplementation protocol
2023, Contemporary Clinical Trials
Obesity and central fat mass (FM) accrual drive disease development and are related to greater morbidity and mortality. Excessive gestational weight gain (GWG) increases fetal fat accretion resulting in greater offspring FM across the lifespan. Studies associate greater maternal docosahexaenoic acid (DHA) levels with lower offspring FM and lower visceral adipose tissue during childhood, however, most U.S. pregnant women do not consume an adequate amount of DHA. We will determine if prenatal DHA supplementation is protective for body composition changes during infancy and toddlerhood in offspring exposed to excessive GWG.
Infants born to women who participated in the Assessment of DHA on Reducing Early Preterm Birth randomized controlled trial (ADORE; NCT 02626299) will be invited to participate. Women were randomized to either a high 1000 mg or low 200 mg daily prenatal DHA supplement starting in the first trimester of pregnancy. Offspring body composition and adipose tissue distribution will be measured at 2 weeks, 6 months, 12 months, and 24 months using dual energy x-ray absorptiometry. Maternal GWG will be categorized as excessive or not excessive based on clinical guidelines.
Effective strategies to prevent obesity development are lacking. Exposures during the prenatal period are important in the establishment of the offspring phenotype. However, it is largely unknown which exposures can be successfully targeted to have a meaningful impact. This study will determine if prenatal DHA supplementation modifies the relationship between maternal weight gain and offspring FM and FM distribution at 24 months of age.
The University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00140895). The results of the trial will be disseminated at conferences and in peer reviewed publications.
Trial registration: ClinicalTrials.gov ID: NCT03310983
Obese female mice do not exhibit overt hyperuricemia despite hepatic steatosis and impaired glucose tolerance
2022, Advances in Redox Research
Recent reports have clearly demonstrated a tight correlation between obesity and elevated circulating uric acid levels (hyperuricemia). However, nearly all preclinical work in this area has been completed with male mice, leaving the field with a considerable gap in knowledge regarding female responses to obesity and hyperuricemia. This deficiency in sex as a biological variable extends beyond unknowns regarding uric acid (UA) to several important comorbidities associated with obesity including nonalcoholic fatty liver disease (NAFLD). To attempt to address this issue, herein we describe both phenotypic and metabolic responses to diet-induced obesity (DIO) in female mice. Six-week-old female C57BL/6J mice were fed a high-fat diet (60% calories derived from fat) for 32 weeks. The DIO female mice had significant weight gain over the course of the study, higher fasting blood glucose, impaired glucose tolerance, and elevated plasma insulin levels compared to age-matched on normal chow. While these classic indices of DIO and NAFLD were observed such as increased circulating levels of ALT and AST, there was no difference in circulating UA levels. Obese female mice also demonstrated increased hepatic triglyceride (TG), cholesterol, and cholesteryl ester. In addition, several markers of hepatic inflammation were significantly increased. Also, alterations in the expression of redox-related enzymes were observed in obese mice compared to lean controls including increases in extracellular superoxide dismutase (Sod3), heme oxygenase (Ho)-1, and xanthine dehydrogenase (Xdh). Interestingly, hepatic UA levels were significantly elevated (∼2-fold) in obese mice compared to their lean counterparts. These data demonstrate female mice assume a similar metabolic profile to that reported in several male models of obesity in the context of alterations in glucose tolerance, hepatic steatosis, and elevated transaminases (ALT and AST) in the absence of hyperuricemia affirming the need for further study.
Sequential diets and weight loss: Including a low-carbohydrate high-fat diet with and without time-restricted feeding
2021, Nutrition
The aims of this study were to assess the effectiveness of a low-carbohydrate high-fat (LCHF) diet with and without a time-restricted feeding (TRF) protocol on weight loss and participating in three sequential dietary interventions (standard calorie-deficit diet, LCHF, and LCHF + TRF) on weight loss outcomes.
Data from 227 adults from the Wharton Medical Clinic (WMC) were analyzed using a unidirectional case crossover design. Data was imputed for 154 patients to create a pseudo-sample in which everyone participated in three dietary interventions: standard calorie restriction, LCHF, and LCHF + TRF.
Patients lost an average of 11.1 ± 1.3 kg (9.8 ± 1.1%) after three sequential dietary interventions (P < 0.0001). Patients lost a statistically significant amount of weight from the standard WMC, LCHF, and LCHF+TRF diets (P < 0.05). With and without adjustment for age, sex, body mass index at the start of the dietary protocol, and treatment time, patients lost a similar amount of weight regardless of the dietary intervention (P > 0.05). Approximately 78.6% of patients achieved ≥5% weight loss with at least one of the diets.
Patients can lose a similar amount of weight regardless of the diet they are following. Approximately 78.9% of patients achieved 5% weight loss with at least one of the diets and lost an average 11.1 kg (or 9.8%). This is nearly double what has been previously reported for one dietary intervention. Thus, participating in sequential diets may be associated with greater absolute weight loss, and likelihood of achieving a clinically significant weight loss
Obesity and Coronary Heart Disease: Epidemiology, Pathology, and Coronary Artery Imaging
2021, Current Problems in Cardiology
Overweight and obesity contribute to the development of cardiovascular disease (CVD) in general and coronary heart disease (CHD) in particular in part by their association with traditional and nontraditional CVD risk factors. Obesity is also considered to be an independent risk factor for CVD. The metabolic syndrome, of which central obesity is an important component, is strongly associated with CVD including CHD. There is abundant epidemiologic evidence of an association between both overweight and obesity and CHD. Evidence from postmortem studies and studies involving coronary artery imaging is less persuasive. Recent studies suggest the presence of an obesity paradox with respect to mortality in persons with established CHD. Physical activity and preserved cardiorespiratory fitness attenuate the adverse effects of obesity on CVD events. Information concerning the effect of intentional weight loss on CVD outcomes in overweight and obese persons is limited.
Gender differences in eating behavior and masticatory performance: An analysis of the Three-Factor-Eating Questionnaire and its association with body mass index in healthy subjects
2020, Journal of Oral Biosciences
The Three-Factor-Eating Questionnaire (TFEQ) is an established instrument to assess eating behavior in terms of dietary restraint, disinhibition and hunger.
The aims of this study were to examine (1) the correlation between eating behavior and body mass index (BMI), (2) the correlation between eating behavior and masticatory performance in terms of bite size and eating speed, and (3) the effects of gender on these correlations in 56 healthy subjects (33 males [21.9 ± 2.8 years old] and 23 females [21.7 ± 2.2 years old]).
We found a significant correlation between restraint and BMI only in females and between hunger and BMI only in males. However, disinhibition and BMI were significantly correlated in both males and females. We also found a significant correlation between bite size and hunger only in males and between eating speed and disinhibition in both males and females.
These findings underline the importance of gender-specific counselling and behavioral treatment of obesity.
SVM-based waist circumference estimation using Kinect
2020, Computer Methods and Programs in Biomedicine
Conventional anthropometric studies using Kinect depth sensors have concentrated on estimating the distances between two points such as height. This paper deals with a novel waist measurement method using SVM regression, further widening spectrum of Kinect's potential applications. Waist circumference is a key index for the diagnosis of abdominal obesity, which has been linked to metabolic syndromes and other related diseases. Yet, the existing measuring method, tape measure, requires a trained personnel and is therefore costly and time-consuming.
A dataset was constructed by recording both 30 frames of Kinect depth image and careful tape measurement of 19 volunteers by a clinical investigator. This paper proposes a new SVM regressor-based approach for estimating waist circumference. A waist curve vector is extracted from a raw depth image using joint information provided by Kinect SDK. To avoid overfitting, a data augmentation technique is devised. The 30 frontal vectors and 30 backside vectors, each sampled for 1 s per person, are combined to form 900 waist curve vectors and a total of 17,100 samples were collected from 19 individuals. On an individual basis, we performed leave-one-out validation using the SVM regressor with the tape measurement-gold standard of waist circumference measurement-values labeled as ground-truth. On an individual basis, we performed leave-one-out validation using the SVM regressor with the tape measurement-gold standard of waist circumference measurement-values labeled as ground-truth.
The mean error of the SVM regressor was 4.62 cm, which was smaller than that of the geometric estimation method. Potential uses are discussed.
A possible method for measuring waist circumference using a depth sensor is demonstrated through experimentation. Methods for improving accuracy in the future are presented. Combined with other potential applications of Kinect in healthcare setting, the proposed method will pave the way for patient-centric approach of delivering care without laying burdens on patients.

View all citing articles on Scopus

View full text

Original articleRegional obesity and risk of cardiovascular disease; the Framingham study

Abstract

Prov Med

Am J Med

J Chron Dis

J Chron Dis

Lancet

Report of the Royal Society of Physicians. Obesity

J R Coll Phys London

Body weight health and longevity

Ann Intern Med

Hazards of obesity, The Framingham Experinence

Acta Med Scand

Health Implications of Obesity: National Institute of Health Consensus Development Statement

Ann Intern Med

Obesity, atherosclerosis and coronary artery disease

Ann Intern Med

Is there an ideal body weight?

Br Med J

Predicting somatotype from body measurements

Am J Phys Anthropol

Anthropometry of flying personnel—1950

The estimation of lean body weight from “skeletal” measurements

Hum Biol

Original article
Regional obesity and risk of cardiovascular disease; the Framingham study